Tips for Starting Rounds

• Choose a physician leader who staff respect and who understands the purpose and value of the Rounds. The physician leader must be willing to participate in the planning group meetings and attend every Rounds. Some hospitals have co-leaders. Also, some physician leaders sit up in the front of the room and help facilitate the discussion with the outside facilitator. This can be very helpful as the facilitator and physician will often look at an issue from different perspectives.

• If possible, find a weekly conference and take it over once a month as Schwartz Center Rounds. This way, many caregivers have it in their schedules already.

• Find a room that will be conducive to Rounds. Conference rooms where you can seat the attendees in a semi circle in front of the panelists are best. Make the environment as intimate and comfortable as possible. Auditoriums are not conducive to Rounds, but can be made somewhat user friendly if no other space is available. Make sure microphones are available if needed.

• Pick a compelling case and topic for the first Rounds that will be interesting and relevant to a large number of caregivers. Make sure the first set of panelists understand the purpose of Rounds as they are different from clinical or ethics Rounds.

• Have a mini dress rehearsal with the panelists to make sure they are all going to talk openly and briefly about their experience with the patient. Make sure only one of them (usually the physician) summarizes the clinical history briefly and that the panelists are not going to be redundant.  Sometimes the physician leader is one of the first panelists because he/she has seen an actual Rounds before and can set the tone. Do the rehersal a week before Rounds, not the day before, to make sure the presenters are fresh.

• Serve a healthy, easy to eat lunch. Try to avoid bagged potato chips and soda cans with pop tops as they make noise when opened. Attempt to avoid boxed lunches as they are usually more expensive. When possible, arrange lunch table such that attendees can move along both sides of the table in order to seat themselves more quickly.  It is sometimes best to put the table outside the room.

• The planning group should wear the button from the Schwartz Center that says “Ask me about The Schwartz Center Rounds” as a way to spread the word.

• Do not advertise the Rounds in areas where patients go because you do not want them to attend the Rounds. That would be awkward and inhibiting for the caregivers.

• Invite hospital administration to attend the first Rounds and say a few words about why the institution is starting Rounds. We have talking points we can provide for this.
  

Tips for Ongoing Rounds

• Three panelists from different disciplines are ideal (eg, physician, nurse, social worker). Other caregivers involved in the case can participate from the audience.

• If the Rounds are hospital-wide (as opposed to being held in the Cancer Center), rotate the departments that are presenting to attract different caregivers. Most sites find they have a regular group of attendees and others come depending on the topic and presenters.

• Usually it works best to find a compelling case for Rounds and then extract the topic from that as opposed to finding the topic and then trying to find a case that illustrates it.
  
  
• Rotate the members of the planning committee to keep Rounds fresh.

• Rounds are a great learning opportunity for medical and nursing students and residents as well as students in social work, chaplaincy, OT, PT, etc. Encourage them to attend. The Rounds help satisfy the ACGME core competency requirements on communication for residents and fellows. Residents are also a good source for cases.

• If nursing attendance is problematic, rotate attendance (eg, nurses cover for each other so some can go one month and others the next)

• Encourage chaplains to attend. They bring a different and valuable perspective to the discussion.
  
  
• Send invitations to department chiefs. If chiefs come, their staff is more likely to attend.
  
  
• Distribute the medical summary of the case before Rounds begin.
  
  
• "Splash" eloquent comments from Rounds on your website.
  
  
• Post a place for topic suggestions on a bulletin board.
  
  
• Have a back-up case in mind if your case falls through.
  
  
• Learn to tolerate a little "silence" at Rounds. People will eventually talk.
  
  
• Put a reminder about Rounds on everyone's voicemail.
  
  
• Make sure the timing is right for presenting a case. Sometimes emotions can be too raw to present a case right away.
  
  
• Point out that your hospital does the Rounds when the Joint Commission visits.
  
  
• Once Rounds are well-established, ask patients or family members to tell their story and give caregivers the change to comment or ask questions. These Rounds are always very powerful.
  

Tips for Every Rounds

• Remind attendees of both patient and participant confidentiality at every Rounds. This helps to create a safe environment in which attendees will feel comfortable sharing their feelings  It is fine to talk about Rounds afterward but avoid revealing what specific individuals said.

• Repeat the purpose of Rounds at the start of each session, eg, to talk about the difficult issues that caregivers face very day. Remind attendees that this is not a problem solving session nor are there right or wrong answers to any of these issues.
  
  
• Have a planning committee member greet everyone at the door to make them feel welcome.
  
  
• Ask attendees who have never been to Rounds before to raise their hands so the facilitator can welcome them.
  
  
• Remind attendees to let go of the "feeling of responsibility" and realize that Rounds are not "teaching Rounds" but "listening Rounds."
  
  
• Remind attendees that there are no "answers" or "right or wrong" at Rounds.

• Ask attendees to turn off their cell phones and beepers or put them on vibrate as constant ringing is very distracting.
  
  
• Vary the intensity of the Rounds. Having too many that are very difficult and intense in a row is not a good idea.

• If  collecting evaluations is a problem, have a member of your planning committee hold up a sign on 8.5 x 11 paper that says “evaluations” in clear view of the facilitator just before closing remarks so the facilitator can remind attendees. As an alternative, station a member of the committee at the door to collect evaluations as attendees leave the room.

 
For tips from hospitals that are doing Rounds see the “Joint Commission Perspectives on Patient Safety” newsletter, March 2006